December 2018 Issue

President's Message

Leo Visser,President, ISTM

It's a windy Sunday afternoon. I am gazing into the rain slashing against the window, contemplating over the past few weeks. The first thing that comes to my mind is the London Tower, with its moat filled with over 10,000 torches scattered at the foot of the Tower's walls and ignited in remembrance for the lives of the fallen in the Great War. This year the 100th anniversary of the Armistice of the First World War was commemorated in many countries all over the world. The impact of the Great War on world's history and on the life of people still resonates even until today. For one, in the aftermath of the War, thousands of Europeans migrated in and outside Europe to look for a better and safer place to live. It is something we easily tend to forget nowadays.

On December 10th, the Global Compact for Safe and Orderly and Regular Migration will be adopted in Marrakech, Morocco. The Global Compact was set out to unite countries rather than to divide on the challenges and opportunities of international migration. However, in several countries in Europe, the Migration Pact has ended in political turmoil as immigration, sovereignty, and identity are currently hot and dividing topics. Japan, on the other hand, has approved a law allowing thousands of foreign migrants into their country to ease labour shortages because of Japan's aging population. As other high income countries will follow the same path of demographic transition in the near future, it will be interesting to see what we can learn from this initiative to stimulate orderly and regular immigration. It reminds me of the closing session of the Migration Health Conference in Rome. There is so much to learn.

In the Netherlands as in many other countries in Northern Europe, we have had a record low water levels in our main river waterways stranding ships. Weather extremes are becoming the normal as climate changes. Large-scale changes from governments and individuals are required if we want to avoid exceeding the 1.5°C temperature set-point by 2030. Unfortunately, the costs will be massive (about 2.5% of the yearly global gross domestic product for 20 years).

We can only hope that bold commitments are agreed upon at the COP24 Katowice Climate Change Conference. However, the start was not very hopeful.

In the meantime, several countries in Europe are witnessing so called "Gilet Jaune" or "Yellow Vest" protests of malcontent citizens against fuel tax rises, high living costs and other issues. The protests started in France, but also spread to Belgium, and it has resulted in substantial damage in cities like Paris and Brussels. Economic frustration, political distrust of poorer working families and uncertainty about the future feeds this spontaneous social unrest and revolt, and politicians are struggling to find an answer to it.

The same lack of trust in the governmental bodies and experts, and the self fullfilling truth finding with the help of Google fuel the worries of anxious parents over childhood vaccinations. Currently, vaccination coverage is below 95% in most European countries. According to European Centre for Disease Prevention and Control (ECDC), several large outbreaks of measles are ongoing in Romania, France, Italy and Greece. MMR vaccine has also become a travel vaccine for travellers to or within Europe.

What do these reflections have to do with travel medicine, you might wonder. Well, I don't you know about you, but after all these years of practicing Travel Medicine I have grown to feel that Travel Medicine carries a responsibility not only to the health of the traveller, but also to promoting sustainable tourism and improving health on a more global scale. This is why I chose "Building Bridges" as my presidential charge: to connect Travel Medicine with our responsibility as health providers in a global community. Happy Holidays to everyone!

Editor's Note

Christopher Van Tilburg,Editor, Travel Medicine News

In 1998, I received a Finnish Suunto Vector watch at an outdoor trade show. Back then, it was state of art wrist-top timepiece, altimeter, and barometer. It has served me well: Mount Rainier, USA; Kilimanjaro, Tanzania; Portillo, Chile; Kala Patar, Nepal. I've been through a half-dozen bands and twice as many batteries. I sent it back to Suunto Headquarters thrice for repair: new bezels and glass. I've had fancier watches. I've tried a watch with a heart rate monitor and Global Positioning System. I once traded a pair of shoes on the streets of Odessa for a military replica. But none ever quite felt right like this scratched, charcoal-gray chronograph.

Welcome to the fifth annual end-of-year print issue of Travel Medicine News —another old-school item. This yearbook documents the happenings of the ISTM: our excellent secretariat under the helm of Diane Nickolson, our leadership group, Journal of Travel Medicine spearheaded by Annelies Wilder-Smith, the various interest and professional groups, and all the other components of our global society like the CTH exam, the ISTM North American Travel Medicine Review and Update Course, and GeoSentinel.

And you'll find info about CISTM16 in Washington DC — save the date! I look forward to seeing many of you at CISTM16, the theme of which is Travel Medicine in a Changing Climate. The theme was chosen to investigate the environmental impact of travel and the climate's impact on vector-borne disease, air pollution, and other illness. Which brings me to the battered, two-decade-old Suunto timepiece. With the ever-changing world and technology, I find comfort in making small changes to reduce consumption, repair and reuse items, and travel lighter with less impact, more thoughtfulness. Especially considering the world's plastic garbage crisis. So I'm keeping the 20-year-old chronograph. I find comfort in its familiarity, dependability, and trustworthiness despite the battered appearance and ill-fitting match with a suit and tie.

The 16th Conference of the International Society of Travel Medicine

5-9 June 2019, Washington DC, United States of America

Blaise Genton,Chair, CISTM16 SPC

Christina Coyle,Co-Chair, CISTM16 SPC

David Hamer,Associate Chair, CISTM16 SPC

Camilla Rothe,Associate Chair, CISTM16 SPC

Jenny Visser,Associate Chair, CISTM16 SPC

The Biennial Conferences of the ISTM (CISTMs) have been the premiere opportunity for travel medicine specialists and practitioners to gather and learn about the latest developments in the field. Delegates attend the conference to keep up to date on advances in the science and the art of travel medicine — they also attend the exposition to see new and innovative technologies, products and services. In the past decade travel medicine has emerged as a distinct multidisciplinary medical specialty involving all travel related aspects of existing medical specialties. CISTMs share the advances in the science and art of travel medicine while allowing those new to the field an introduction to this exciting medical discipline.

"Travel Medicine in a Changing Climate" has been chosen for the overall theme of the next CISTM in 2019. The Call for Abstracts is now open and will be accepted through 1 February 2019. All submitted proposals have been reviewed and the Scientific Committee has put together an exciting program for the meeting.

Plenary talks will be given on climate change, antibiotic stewardship, arboviruses and eHealth. Symposiums will include topics such as sexual health in travellers, military travel, air pollution and travel, malaria and vaccines. We have invited the American Society of Tropical Medicine and Hygiene and the International Society for Infectious Diseases to each give a symposium as well as some of the ISTM Interest and Professional Groups. Workshops are a more interactive way to provide valuable information and will include topics such as female travellers, international adoption, rabies, rickettsial diseases, digital apps for travel medicine and a session on personal stories. This meeting will also see a couple of debates, one on Zika and the other on Japanese Encephalitis. There will be a panel discussion on rabies and a few new types of sessions such as one mimicking a game show and the other giving the opportunity for invited speakers to challenge commonly held belief(s) or practice(s) in travel medicine.

Dr. Alan Magill, past president of the ISTM, was the Director of the Malaria Program at the Bill & Melinda Gates Foundation and had been deeply involved in the fight against malaria. He set his goal to ultimately eradicate malaria using innovative tools and strategies. He passed away prematurely, when he was still at the forefront of all important malaria initiatives. To honor Dr. Magill, the Scientific Committee has once again included the Alan Magill Memorial Lecture with a malaria topic.

Secretary-Treasurer's Report

Peter A. Leggat,Secretary-Treasurer, ISTM

Reflections 2013-2019

In June 2019, I will hand over the reins of Secretary-Treasurer to Mike Jones, who is a very experienced campaigner and will be a great asset to the ISTM in this role. Hence, this will be my last Magazine article as Secretary-Treasurer and I thought I would reflect on some of the ISTM highlights that I have seen since becoming Secretary-Treasurer in 2013. I know there will be many more that cannot be covered here, but hopefully the following gives you an idea of some of what has happened over the past six years.

Membership and 25th Anniversary

Membership in the ISTM is more than 4000 for the first time.

Membership growth has been around 68% since 2013 with 96 countries represented.

The Society celebrated 25 years with a number of special events in Barcelona at the CISTM15 in 2017.

Member benefits have greatly expanded, including the Member Advantage Program and exclusive online member Webinars, in addition to the popular Global Travel Clinic Directory (with over 1 million visits each year).

Finances

The ISTM has good reserves and the institution of an Investment Policy Statement ensures that the investment advisor and the ISTM Executive Board keep the reserves at a level that reaffirms sustainability of the Society, in case there was a significant negative event, such as a major conference cancellation or loss or downturn in markets.

The ISTM has been investing in the future, especially with outreach to regional and national travel health societies as well as the recent International Conference for Migration Health in Rome.

There has been significant Low and Low-Middle Income Country (LMIC) outreach in offering special membership dues, low rates to take the CTH, increase in bursaries and research award grants dedicated for their research.

Conferences

Conferences of the ISTM (CISTMs) continue to be a major event for members and those working in travel medicine and related areas globally.

Recent conferences have included Maastricht (13th CISTM, 2013), Québec (14th CISTM, 2015), Barcelona (15th CISTM, 2017), which was also our 25th Anniversary Conference, and we have Washington DC (16th CISTM, 2019) coming up, which is shaping up as a must-attend event.

The CISTM now includes the Alan Magill Lecture in recognition of ISTM Past President, the Late Colonel (Retd) Alan J. Magill, formerly Director of Malaria Programs at the Bill & Melinda Gates Foundation.

Two themed conferences (have also been held between 2013 and 2019: one on Travel and Wilderness Medicine (2013 also 6th Regional Conference of the ISTM) in conjunction with the Wilderness Medicine Society and one on Migration Health (2018), as previously mentioned, which had the support of a number of national and international organizations.

The 7th Regional Conference of the ISTM was held in conjunction with the Southern African Society of Travel Medicine in Port Elizabeth in 2016.

GeoSentinel

Following the retirement of David Freedman after many years of dedicated service to GeoSentinel in 2013, ISTM negotiated a change in principal investigators selecting David Hamer.

There has been an increase in number of sites. At last count, it was up from 56 to 72 sites (in 30 countries), and 225 affiliate members.

The number of patient records has increased from 194,500 to 311,000 at last count.

The "CDC" grant funding has increased by 50% with some support from PHAC and considerable support from ISTM.

There continues to be the generation of high quality publications from this network's research.

Journal and other publications and e-media

The journal has changed publishers from Wiley to Oxford University Press and Editors-in-Chief from Prof Eric Caumes to Prof Annelies Wilder-Smith.

There is a continuing increase in stature and impact factor and publication time has been reduced to 72 hours once accepted outright.

ISTM membership Newsletters and Magazines continue to be published at regular intervals providing updates for members on a whole range of ISTM activities. Well done to the newsletter/magazine Editor-in Chief, Christopher Van Tilburg and the ISTM Secretariat.

The ISTM website has been redeveloped with a MyISTM member portal, but like all websites, there is pressure for constant change and upgrades.

There is expanded ISTM social media presence now. It is an important means of member communications and outreach to the wider world.

Research

ISTM Research awards funding has more than tripled since 2013-14.

There have also been a number of targeted awards in recent years, focusing on migration and also for Low and Low-Middle Income Country Investigators.

CTH® Exam

Because of the demand, ISTM began offering the Certificate of KnowledgeTM (CTH®) exam 3 times every 2 years instead of once a year.

There has been an increase in CTH® holders from 1799 to 2679 in 60 countries.

Fellowship and Honorary Membership

It is a sign of maturity in the Society and the field that the ISTM is now recognizing members as Fellows with biennial inductions since 2016, as part of a 25th Anniversary Project.

Honorary membership has also been conferred on the ISTM founders.

Membership Groups

ISTM Interest groups have more than doubled – we now have 8 with record participation of members in these groups.

ISTM Foundation

The ISTM Foundation has been established allowing tax deductibility in the United States of America.

A guidelines summit on Travellers' Diarrhea (TD) was held in 2017 and significantly supported by the ISTM Foundation. The TD summit has led to a significant publication in the Journal of Travel Medicine. Another summit is planned on Malaria in February 2019.

ISTM Secretariat

Last but by no means least are our dedicated staff led by Executive Director, Diane Nickolson, who has provided exceptional leadership, stability and corporate knowledge over the past 6 years.

Staff have grown by 2.5 positions to accommodate supporting GeoSentinel and new activities in house. An ISTM Deputy Director, Jodi Metzgar, has also been appointed. This is not to mention all the consultants working for the Society in accounting, audit, legal, investments, IT, and other areas.

The Atlanta Secretariat office moved from cramped conditions in Decatur to offices that are fit for purpose and future expansion in Dunwoody, although the Secretariat has recently had to move again within the same building.

I wish to acknowledge the efforts of all past Secretary-Treasurers, who have gone before me, in particular David Freedman, who mentored me in the role. I wish Mike Jones all the best when he formally assumes the role of Secretary-Treasurer in June of 2019. I have appreciated all the efforts of all the Officers, Executive Board, Leadership Council and other ISTM committee and group members, who have supported the ISTM. Thank you to all members for their support of the Society. Special thanks to Diane Nickolson for assisting me with these highlights.

News from the Secretariat

Diane Nickolson,Executive Director, ISTM

ISTM Membership breaks 4000!

I am excited to report that for the first time in our history, the ISTM has more than 4000 Members. Our last fiscal year counted 4080 members from 96 countries. 68% of ISTM members are doctors, 15% nurses and 12% pharmacists. The number of pharmacist members has been growing quickly; in the past 10 years the percentage of pharmacist members has increased from 1% to the 12% we have today.

The ISTM continues to have a large percentage of membership from primarily English-speaking countries. Eleven countries account for approximately 84% of our membership, listed in order from the most to the least number of members they are:

United States of America

Canada

Australia

United Kingdom

Japan

Switzerland

The Netherlands

New Zealand

Belgium

South Africa

Thailand

North America captures around 60% of the ISTM membership, followed by Europe at 17%, then Asia and Oceania each at 9%.

In 2013 the ISTM Executive Board established a discounted rate for Low and Low-Middle Income Countries (LMIC). I'm delighted to report that we now have 100 Members who have taken advantage of these discounted rates, representing areas that formerly were not engaged in the society.

I am very proud of the growth the ISTM has seen especially over the past 10 years — we have doubled our membership since 2006. The ISTM Leaders and Executive Boards have been very focused on working towards reaching out to travel medicine professionals on a global scale as well as increasing member benefits. We are fortunately seeing the results of these efforts.

Phyllis E. Kozarsky,Special Advisor
on behalf of the
United States Centers
for Disease Control
Karin Leder,Chair,
Data Collection
Working Group

One of ISTM's flagship programs is the GeoSentinel Global Surveillance Network. This global network was created in order to gather and share surveillance data concerning travel- and immigration-related infectious diseases. With financial support from ISTM, the United States Centers for Disease Control, and the Public Health Agency of Canada, GeoSentinel collates and analyses data on illnesses in travellers, migrants and refugees, and communicates information on travel-related illness to the travel medicine and public health communities. GeoSentinel sites participate in the surveillance and monitoring of travellers to detect alarming diagnoses or atypical events and monitor trends. These activities allow for the creation of a unique database on travel-related morbidity and, through information sharing globally, informs public health on changes in infectious disease epidemiology.

There are currently 72 GeoSentinel sites, located on five continents, with 27 in North America, 25 in Europe, 10 in Asia, 3 in South America, 3 in Africa, 2 in Australia/New Zealand, and 2 in the Middle East. As of September 2018, there are over 310,000 patient records in the GeoSentinel database.

As part of the GeoSentinel structure, there are four working groups that share the work and leadership of the program. The Data Collection Working Group, chaired by Karin Leder (Melbourne, Australia), is responsible for the quality of the data entry tools which make sure the sites are capturing all relevant travel-related illnesses in a harmonized manner. The Enhanced Clinical Surveillance Working Group, chaired by Kevin Kain (Toronto, Canada), focuses predominantly on pathogen-centered and clinically descriptive projects. The Special Populations Working Group, chaired by Philippe Gautret (Marseille, France), develops and carries out projects within GeoSentinel to address issues related to special populations such as migrants and medical tourists. The Tracking and Communications Working Group, chaired by Vanessa Field (London, United Kingdom), is responsible for reviewing routine and alarming diagnoses to identify potential sentinel outbreaks, creating internal alerts for Sites and Affiliate members and rapid reports for external publication, and maintaining communication within the network and with external partners and public health authorities.

GeoSentinel uses its travel-related illness data to publish in peer-reviewed journals. Recent publications include Illness among US resident student travellers after return to the USA: a GeoSentinel analysis, 2007–17. Journal of Travel Medicine. 2018 Sep 15;25(1) and Epidemiological aspects of travel-related systemic endemic mycoses: a GeoSentinel analysis, 1997–2017, Journal of Travel Medicine, 25.1 (2018). In addition, in the first two months of 2018, GeoSentinel sites identified six patients with yellow fever in travellers to Brazil, which along with several other exported cases, led to an Early Access MMWR publication. These cases highlighted the risk of yellow fever disease in unvaccinated travellers (four of the ten cases were fatal), and provided evidence of yellow fever transmission on Ilha Grande, closely located to Rio de Janeiro, in Brazil.

The GeoSentinel Sites meet twice a year to discuss network matters, and share interesting ideas, cases and research reports. The four working groups have a chance to meet in person and report to the larger group on the projects they have been working on. If you are interested in becoming a GeoSentinel Site or Affiliate Member, please visit the ISTM Website and click on the GeoSentinel page or contact the ISTM Secretariat at GeoSentinel@ISTM.org.

Challenging Cases: Voice Your Opinion

Mary-Louise Scully

Nancy Piper-Jenks

We've enjoyed another year of hearing from our members about both pre and post travel dilemmas. In case you missed them, all the prior cases are available to view on the ISTM website under Educational Cases.

If you haven't had a chance to participate, maybe this next case can be your challenge!

A 45-year-old male presents for a routine physical. He is originally from Honduras but immigrated to Canada when he was 25 years old. He is healthy, has no history of asthma or allergies. He has had no recent international travel except to Europe.

His physical exam is normal but his routine labs show a total WBC of 8.0 (Ref 4-10.0 10*3/uL) 9 % eosinophilia (Ref 0.0 – 5.0 %), and an absolute eosinophil count of 0.72 ( Ref 0.0- 0.40 10*3/uL). EKG and all other labs (liver, kidney and urinalysis) are normal. You order stool for ova and parasite x 3 and all 3 return negative.

At this point, would you just reassure the patient or would you proceed with further testing, and if so what would you laboratory tests would you order and why?

Send your response to maryscully.ms@gmail.com. Responses should be about 300 words and address the specifics of the case.

Challenging Cases: Voice your Opinion is a great way to challenge your knowledge and learn from our international colleagues.

2018 The Year in Review

This year's Travel Medicine Year in Review theme is traffic — whether movement by air or water or roadway or rail or foot — the globe was congested with stories about pollution, pox, and politics.

These are urgent...

Ebola is still a disease of concern but not an emergency. In August, WHO was notified by the Ministry of Health of the Democratic Republic of the Congo of Ebola Virus Disease in North Kivu province and subsequent cases in Ituri Province. However, in October, the WHO Emergency Committee issued a statement that a Public Health Emergency of International Concern (PHEIC) should not be declared for Ebola, but still exhorted ongoing vigilance. Encouragingly, the experimental rVSV-ZEBOV vaccine, which has demonstrated efficacy in clinical trials, has been administered to over 3,000 people in Ebola affected areas.

Polio remains a disease of urgent concern. In August, the WHO Emergency Committee unanimously agreed that the risk of international spread of poliovirus remains a PHEIC. Countries with WPV1, cVDPV1 or cVDPV3 (wild polio or circulating vaccine derived polio virus) and possible risk of international spread include Afghanistan, Pakistan, Nigeria, Papua New Guinea, and Somalia. Countries with cVFPV2s include DR Congo, Kenya, Nigeria, Syrian Arab Republic, and Somalia. Countries that are no longer infected by WPV1 or cVDPV but still remain vulnerable are Cameroon, Central African Republic, Chad, and Niger.

Nipah is an emerging disease of public health importance. It was first recognized in 1998-1999 in Malaysia and Singapore in an outbreak among pig farmers, and has been reported in India and Bangladesh since 2001. An outbreak in Kerala, India this year was quickly contained by health authorities. The case fatality rate can range between 40-75%. Nipah is on the WHO priority list of emerging diseases that could cause a global pandemic.

Monkeypox is another disease of urgent health concern in Nigeria. As of September 2018, there were more than 100 confirmed cases of monkeypox, a zoonotic disease with symptoms similar to smallpox although less severe, reported from Nigeria, including deaths. As of October 2018, three cases of monkeypox have been reported in 2 travellers to the United Kingdom and 1 to Israel, the latter reported through GeoSentinel.

Air pollution levels are still dangerously high in many parts of the world. WHO reported that globally, 90% of people are exposed to air with high pollutant levels. Estimates are 7-12 million people die every year due to outdoor and household air pollution. On a positive note, UN Environment and WHO have agreed to a collaboration to accelerate action to curb environmental health risks that contribute to these deaths.

These remain a caution...

Yellow Fever. The internet and news media was clogged with information about Yellow fever this year, from outbreaks to vaccine shortages. Good news comes from the Eliminate Yellow fever Epidemics (EYE) in Africa — 27 high-risk African countries will receive the yellow fever vaccine — that's nearly one billion people — by 2026 with support from WHO, Gavi — the Vaccine Alliance, UNICEF, and more than 50 health partners.

Cholera vaccine efforts are under way in war-torn Yemen. A joint WHO-UNICEF campaign vaccinated more than 300,000 people in 6 days in Yemen during a pause in fighting known as the "Days of Tranquility."

Influenza still needs attention. WHO, CDC, and other global health partners estimate up to 650,000 deaths annually are associated with respiratory diseases from seasonal influenza, an increase from 250,000 – 500,000 deaths over a decade ago. All the more concerning because the new numbers don't include deaths from non-respiratory diseases, which were accounted for in the older data.

Measlesoutbreaks of this disease continue unabated as target vaccination rates are not being met. In Europe, the highest number of cases were reported from these countries as of July 2018: Romania (4317), France (2588), Greece (2238), and Italy (1716), with 31 deaths across Europe due to the disease. ([Communicable Diseases Threats Report (CDTR]). Only 4 EU/EEA countries have achieved the 95% target rate for vaccination.

WHO List of Essential Diagnostic Tests. Many people around the world do not have access to diagnostic tests or to accurate ones, and may be misdiagnosed or incorrectly treated. In May, WHO published its first Essential Diagnostics List, a catalogue of diagnostic tests for the most common conditions and a number of global priority diseases.

Tafenoquinereceived approval for Plasmodium vivax (P. vivax)radical cure and prevention. Tafenoquine is an orally-active 8-aminoquinoline anti-malarial drug that was approved in July by the US FDA for radical cure of P. vivax malaria in patients aged = 16 years who are receiving appropriate antimalarial therapy for acute P. vivax malaria (300mg) and in August for the prophylaxis of malaria in patients aged = 18 years. KrintafelTM was developed by Medicines for Malaria Venture and GSK. ArakodaTM was developed by 60 Degrees Pharmaceuticals for the prophylaxis of P.vivax malaria (100mg). KozenisTM was approved by the Australian Therapeutic Goods Administration (TGA) for the radical cure P. vivax malaria in patients >16 years. A priority review has been granted for GSK's Marketing Authorization Application for tafenoquine for radical cure by the Brazilian Health Regulatory Agency (ANVISA).

Journal of Travel Medicine

Annelies Wilder-Smith,Editor-in-Chief,
Journal of Travel Medicine

The ISTM is appreciative of the tireless work and contributions of the entire JTM Editorial Board.

2018 was a transitional year for the ISTM JTM, as mid-year Eric Caumes, France, completed his term and Annelies Wilder-Smith, Switzerland became the 4th Editor-in-Chief of the Journal. The ISTM acknowledges the following JTM Editorial Board Members for their tireless work and contributions to the Journal.

Travel Medicine Review and Update Course

12-13 April 2019
Atlanta, Georgia, United States of America

The 2019 ISTM North American Travel Medicine Review and Update Course will be held in Atlanta Georgia, United States of America.

The Review Course offered by the International Society of Travel Medicine is designed to review the Body of Knowledge for the Practice of Travel Medicine and to highlight recent developments in Travel Medicine.

The curriculum will cover topics relevant to physicians, nurses, pharmacists and other health care professionals who provide medical care and advice to travellers, expatriates, and migrants. The sessions offered will include travel clinic management issues, principles of immune response, risk assessment, and a travel vaccine overview. The expert faculty will present topics including epidemiology, enteric infections, travellers' diarrhea, malaria and other vector-borne disease, adventure and wilderness travel, environmental exposures, and evaluation of illness in returning travellers. The care of special groups such as pregnant women, pediatric travellers, immigrants, VFR travellers, diabetics, and immunocompromised hosts will be discussed. Recent developments and advances in travellers' diarrhea, immunizations, malaria medications, and emerging infectious diseases will be highlighted. Participants will have ample opportunity to interact with the faculty through interactive sessions and informal discussions.

Information on the course venue and registration is located on the ISTM website at: www.ISTM.org

This council is made up of an amazing group of professionals who bring many different skills and experiences to the table, as well as an eagerness to work hard to fulfill the goals of the Nursing Professional Group. I feel very privileged to be a part of this exceptional group.

We are in the process of updating our webpage to enable members to have easy access to useful information regarding NPG events, workshops, awards, and learning opportunities at CISTM16. Please check on our progress at: www.ISTM.org/nursinggroup

The steering council is committed to those nurses who are doing research in the field of travel health and have decided to start highlighting individual work on our webpage. In November, the work of Jutarmas Olanwijitwong (Thailand) was posted on the NPG webpage. Jutarmas works at the Thai Travel Clinic, Hospital for Tropical Diseases and Faculty of Tropical Medicine, Mahidol University in Bangkok. Her most current work is entitled "Health Problems Among Thai Tourists Returning from India".

If you know of any NPG members you would like to see highlighted, please contact a member of the steering council.

The NPG and PPG steering committees are currently working on a joint research project to establish an updated database of national/regional public health risks related to travel.

The steering council is also really excited that we have the opportunity to present two workshops at CISTM16 in Washington DC in June 2019. We will present a pre CISTM16 workshop entitled: "Destination Southeast Asia: An Overview with Case Studies". One key component of the workshops will be the presenters comparing and contrasting the needs of Boomers vs. Millennials. Jutarmas will be involved in preparing the workshop and brings a wealth of first-hand knowledge on this topic. The second workshop entitled "The Imperfect Travel Health Consultation" will be presented in the scientific program. Please support our NPG by attending these workshops.

I would like to remind the NPG that each conference year we present two nursing awards: the "Distinguished Nurse Leadership Award" and the "Emerging Nurse Leader Award". For more information on each of these awards, and how to apply please visit our NPG webpage. Applications must be received by Jodi Metzgar by mid February 2019.

Looking forward to seeing everybody in Washington DC next year!

Heather Connor,Chair, ISTM Nursing
Professional Group

Pharmacist

Lee Baker,Chair, Pharmacist
Professional Group

Our mission:

The mission of the Pharmacy Professional Group (PPG) is to promote the role and serve as a resource for those pharmacists interested in the practice of travel medicine.

Accomplishments for 2018:

Members of the PPG Steering Council have been working diligently throughout the year.

Two members were awarded a grant by ISTM to review travel health apps on both the iOS and Android platforms to identify apps that could be considered a "gold standard" to recommend to providers and patients.

In September, three members of the Steering Council presented posters at the most recent International Pharmaceutical Federation (FIP) World Congress in Glasgow, Scotland. One poster described activities of the PPG and the results of a needs assessment survey completed by PPG members. The second poster, presented information about the PPG's database of information for travellers carrying and obtaining medicines overseas. FIP is the largest global pharmacy conference in the world. Members of the Steering Council discussed with leadership of FIP on possible collaborations to better serve the needs of membership in both organizations and to promote the work of travel health pharmacists.

One member of the Steering Council has been invited to conduct a workshop on Travel Health for the Fiji Pharmaceutical Society in October. The topics to be discussed are travel health related issues that pharmacists may encounter with travellers from Australia, New Zealand and China visiting Fiji.

We continue to work on the bibliography of pharmacist published work in travel health.

Chair-Elect, Derek Evans has been awarded the Fellowship of the Royal Pharmaceutical Society (Glasgow).

How you can join: Pharmacists interested in joining the PPG can affiliate with the group at the time of their annual membership renewal.

Interest Groups

Migrant and Refugee Health

Masatoki Adachi,Chair, Migrant
and Refugee Health
Interest Group

The International Society of Travel Medicine's Migrant and Refugee Health Interest Group is a group aimed at raising awareness among travel medicine providers regarding the range of health issues in migrant populations, developing strategies and tools for addressing health issues among migrant populations, and encouraging use of the travel health encounter as an opportunity for health promotion among migrants. All ISTM Members who are interested in the health of migrants, refugees, and other mobile populations are welcome to join the group. Please contact the group chair via e-mail or the ISTM secretariat to join!

Past Event: International Conference on Migration Health

A migration-themed conference was held on 1-3 October 2018, in Rome, Italy. The conference was aimed at bringing together academic knowledge and experience relating to migration and health from around the globe. The conference attracted many clinicians as participants, as well as public health and policy makers. In collaboration with conference partners, our Interest Group organized an early morning session titled, "Protection and Promotion of Health and Safety of Migrant Workers" to talk about the health of migrant workers. In the session, data was presented relating to labor migration and "three 'D' jobs" ("dirty, dangerous and demanding"), whose workers face high risks of work-related injuries and diseases.

Upcoming Event: CISTM16

The main congress for ISTM (CISTM16) is scheduled to take place in Washington, DC on 5-9 June 2019. The Interest Group plans to continue working with major international organizations, including U.N. agencies to help increase awareness of global health trends and policies among travel health providers. The Interest group is currently working to organize sessions and workshops to address migration and health issues relevant for travel health providers. We hope to provide helpful resources and data for the audience.

Military Travel

Olivier Aoun,Chair, Military Travel Interest Group

As most of you know, the ISTM Military Travel Health Interest Group was founded summer 2017 and its leadership council elected in 2018. As you can see below, its organization is unlike the previous interest groups. Our group is opened to all healthcare providers interested in or caring for service members. A unique military symposium with original topics was approved for the next CISTM that will be held in Washington 5-9 June 2019. In addition, a military pre-course was submitted for the same conference. We are currently working on the merchandizing and promotion of the group as well as the organization of a social program during CISTM16.

Help us in promoting our group!

Olivier Aoun,France, Chair

Holly Doyne,United States of America, Co-Chair

Mildred Casey-Campbell,Canada, Secretary/Treasurer

Peter Leggat,Australia, Scientific Coordinator

Sean Smith,United States of America, Local Organizer

Olivier Aoun,Military Travel Interest Group Chair

Older Traveller

The youngest interest group focuses on older travellers

Gerard Flaherty,Founder, Older Traveller Interest Group

Andrea Rossanese,Founder, Older Traveller Interest Group

Robert Steffen,Founder, Older Traveller Interest Group

Joseph Torresi,Founder, Older Traveller Interest Group

As we all know, the population is ageing, and senior citizens either continue to travel to exotic destinations or they realize that now they have time to do so. Older travellers as compared to the younger generation may have differing host factors, for example there is immunosenescence, and as a consequence the older traveller is at an increased risk of developing a range of bacterial and viral infections. In addition, older travellers not only develop waning immune responses to vaccines but also have reduced responses to a range of vaccines. Pre-existing conditions may result in polypharmacy, and there is an increased risk of accidents at the unfamiliar location.

These people have ample time and often elect to spend long periods in an environment far from home. A better understanding of the range of health issues confronting older travellers and the development of more effective vaccination strategies for these travellers are now evolving as new and important priorities in travel medicine.

Thus, a quartet of ISTM members proposes the following charter:

Provide a forum for exchange of ideas between ISTM Members interested in travel health issues for older travellers

We welcome your participation in the new interest group. To join the interest group there is no fee; simply log into your ISTM member account at www.ISTM.org, and add the group to your membership account. Or email the ISTM Secretariat at ISTM@ISTM.org who would be happy to process this for you.

Pediatrics

Stefan Hagmann,Chair, Pediatrics Interest Group

The Pediatric Interest Group Council has been busy in 2018 supporting educational programs around the globe. In March at the 12th Asia Pacific Travel Health Conference in Bangkok, Pornthep Chanthavanich, Associate Professor at the Department of Tropical Pediatrics, Mahidol University and myself co-presented during a workshop on "Paediatrics in the Tropics". The audience was challenged to help solve tropical infectious disease cases, and relevant treatment and prevention strategies were discussed. In April, the first pediatric-themed ISTM webinar ever went live with Mike Starr from the Royal Children's Hospital in Melbourne, and Karl Neumann, Clinical Associate Professor of Pediatrics emeritus, Weill Medical College of Cornell University in New York, discussing "Preventing Malaria in Paediatric Travellers" and "Preventing Mosquito Bites". This well received event was followed by our next supported activity in May at the 7th Northern European Conference on Travel Medicine in Stockholm. Lynda Bramham from NaTHNaC, London, Sarah Kohl, the current ISTM Digital Communication Committee Chair from McMurray, Pennsylvania, and Shirley Molitor-Kirsch from Children's Mercy Hospital in Kansas City, Missouri organized the interactive workshop "Pediatric Case Discussions". Case presentations were presented to highlight the complexity of pretravel care for infants, children, and adolescents. Electronic polling and live audience questions allowed for a lively discussion.

In 2018 the Pediatric Interest Group Council had also decided to plan for future pediatric professional education activities. With that aim in mind, Shirley Molitor-Kirsch took on the task to design an online survey that was launched and emailed to all ISTM members over the summer. Shirley is currently busy analyzing the responses. Please expect a report at the upcoming CISTM16 in Washington, DC in 2019.

How do you keep up-to-date with new developments in the scientific literature during your busy clinic job routine? This is clearly a vexing problem for most of us. Now, please take note that all members of the Pediatric Interest Group are kept informed about important pediatric travel medicine research with the routinely updated Pediatric Interest Group Bibliography. We are grateful to John Christenson, Indianapolis, Indiana, United States of America who tirelessly for many years has kept an eye on the scientific literature. Obviously, a perk when joining the ISTM Pediatric Interest Group!

I hope that this short overview stirred up your interest for the Pediatric Interest Group, you decide to join us, and we hear from you via email or on the listserv.

Stefan Hagmann,United States of America,Chair, Pediatrics Interest Group

Psychological Health of Travellers

How to build the psychological capital among travellers and expatriates?

This was the theme of a presentation made last September at the 'Focus on Reality' conference in Cape Town organized by the South African Society of Travel Medicine. Interest group steering committee members, Marius van Aswegen, Fanie Jute, and Tullia Marcolongo discussed the psychology of travel addressing the stressors affecting both long-term assignees and short-term travellers in challenging environments and where appropriate psychological care is not available. If you counsel travellers, voluntourists, and study abroad participants consider the exclusions and limitations of travel insurance coverage for mental health conditions, travel with or finding psychotropic medication in the destination country, as well as access to psychiatric care. For expatriates, the success of an assignment depends on a multitude of factors including an indvidual's emotional intelligence, personal and work relationships, communication skills, adjustment to the host culture and resiliency. As long-term assignees must adjust to more demanding business environments, the risk of failed assignments increases. With pre-deployment guidance and interventions with a focus on building psychological capital, the high financial and psychological costs of an unsuccessful placement can be mitigated.

Look out for updated literature sources, screening checklists and mental health materials for your travellers on the interest group's listserv. We look forward to meeting you at CISTM16 in Washington.

It has been a relatively quiet year for the Responsible Travel Group (RTG). (We seem to need a good conference event to stimulate the wider group into more active participation!)

Rhonda Martin (United States of America), previous chair of the leadership group, had been doing some sterling work, updating the RTG resource library, including writing a new booklet entitled: 'The Responsible Traveller'. Rhonda stepped down in June 2018, to pursue a new career in the organic catering field. Her contributions and warm enthusiasm will be much missed by the group.

Jim Bond (Scotland & Zambia) has since taken over as Acting Chair in the interim until new elections in Feb 2019. We also welcomed Caroline Nash (Australia), as a co-opted member onto the group. The RTG was invited to submit a proposal for a talk or workshop for the SASTM Pan-African Travel Medicine Congress in September (always a favourite on the calendar), but sadly, none of the core group was able to attend this year.

RTG has been invited to submit a proposal for a pre-Congress workshop at the CISTM in June 2019 in Washington, DC. A call was put out to the wider group for ideas, but in the absence of any received, Jim has proposed re-running the workshop on 'The ethics of expeditions' from Port Elizabeth, with more time for small group discussions and a decent refreshment break.

Jim has also written another 'Responsible Traveller' piece on the 'Ethics of current schistosomiasis prevention advice', which will be published in the January's hard copy issue of the Journal of the British Global & Travel Health Association (BGTHA).

I'm sure 2019 will herald more exciting news, especially if we get some new members in the leadership group. Do please consider putting yourselves forward!

Jim Bond,Chair, Responsible Travel Interest Group

Student Travel Abroad

Mark Newell,Chair, Student Travel
Abroad Interest Group

Students of all ages are increasing their participation in study abroad. How can we effectively meet their needs? The Student Travel Abroad (STA) interest group is devoted to sharing best practices on caring for students who travel, conducting research on the needs of student travellers, and promoting a coordinated approach to providing healthcare for students who travel.

Student travel has evolved from short vacations during semester breaks and courses taken at sister universities to more complex travel plans abroad, often to remote locations and may involve volunteering. Practitioners increasingly help students manage chronic health conditions while travelling, in addition to their typical travel health concerns. Additionally, inbound foreign students often return to their home country for a vacation visiting friends and relatives (VFR trips) or an outbound trip to locations dissimilar from their home or their current educational institution.

In short, students are travelling all over the world, to more remote locations, for longer periods of time. This presents unique challenges for those who care for them.

The STA is sharing best practices through workshops at the meetings of the International Society of Travel Medicine (ISTM) and the American College Health Association (ACHA). We are developing relationships to provide even more professional development. In addition, we provide a clearing house of resources, templates, and educational materials which is hosted on the MyISTM website in the STA library.

Despite the global expansion of study abroad, there is still much to learn about this group of travellers. The STA is currently partnering with the United States Centers for Disease Control (CDC) in a research project to learn more about the health risks of student travellers. This exciting research will help to focus our efforts on the identified health risks of student travel and assistance provided to them by both university student health centres and study abroad offices.

Student travel is not an isolated event; it's more like a team sport. The STA is working with the educational community to develop a team approach for study abroad programs. Only when all parties work together such as the student, the family, the academic departments, administration, health services and risk management will students receive the care they need.

We are open to new members. If you enjoy working with students, have an idea or a project you want to deploy, or simply want to learn more about STA we'd love for you to join our interest group. It's easy through the MyISTM website. We hope you will join us for our Workshop and Pre-workshop at CISTM16 in Washington, DC in June.

If you reside in a Low or Low-Middle Income country or if you are a young investigator, you may qualify for a CISTM16 bursary.

Submit your CISTM16 Abstracts Now!

The deadline for abstract submission is 1 February 2019.

The Scientific Program Committee (SPC) of the 16th Conference of the International Society of Travel Medicine (CISTM16) invites you to submit an abstract for poster or oral presentation under the following categories:

We have a limited number of bursaries available for individuals who reside in a country classified by the World Bank as Low Income or Low-Middle Income and young investigators. More information including eligible countries, candidate requirements, deadlines and application can be found on the website.

If you have any questions or concerns, please contact the CISTM16 abstract team: CISTMSPC@ISTM.org.

Research Awards

Mary Wilson,Co-Chair,
Research and Awards Committee

Martin Grobusch,Chair,
Research and Awards Committee

The Research Awards Committee was pleased to receive, once again, a high volume of excellent proposals from all over the world, proposing to apply a wide range of research methodology to a broad spectrum of research questions relevant to the vast field of travel medicine.

Health Knowledge, Attitudes and Practices on Traveller's Diarrhoea among International Travellers to Kenya from Western and Asian countries
Daniel Munyambu Mutonga, Kenya, Principal Investigator.

For the first time this year, ISTM has offered the possibility for ISTM Interest and Professional Groups to apply for Research funding. This year, we are happy to announce the ISTM Pharmacist Professional Group has received this funding for their proposal.

ISTM Interest and Professional Group Award:

Review of mobile applications for travel medicine for practitioners and patients
Sheila Seed, United States of America, Principal Investigator on behalf of the ISTM Pharmacist Professional Group.

We thank all Research Award Committee Members for their enthusiasm and hard work. Congratulations to our 2018 winners!

Slide Set

The ISTM Slide Set was updated in late 2017. As we have split it into four chapters, you can now purchase it by chapter or the complete set at a discount. Visit the ISTM website at www.ISTM.org to order or for more information.

Chapter 1: Introduction to Travel Medicine

Chapter 2: Travel Topics and Special Considerations

Chapter 3: Travel Vaccines

Chapter 4: Vector-Borne Diseases

We would like to thank the ISTM Professional Education Committee for their work on this project.

A Productive 2018

The Professional Education Committee (PEC) had a productive 2018 thanks to the many contributions of the committee and many ISTM members.

Below is a few highlights of the various projects as well as recognition and a special thanks to those members who helped make these activities a success.

ISTM Webinars

Many thanks to Sarah Kohl, United States of America, Lin Chen, United States of America, and Jodi Metzgar, United States of America, for their efforts in helping organize the webinars, as well as a very special thanks to the speakers and moderators.

Preventing Malaria in the Paediatric Traveller — Mike Starr, Australia with Moderator Karl Neumann, United States of America

Challenging Cases – Voice your Opinion

Nancy Piper-Jenks, United States of America and Mary-Louise Scully, United States of America

These educational cases appear in Travel Medicine News. It's a great opportunity for all members to get involved in discussing management of a difficult travel related dilemma. After publication in Travel Medicine News, the cases are then posted on the ISTM website under Educational Cases. Our 2018 thanks go out Stephanie El-Chakieh, Canada, Anne McCarthy, Canada, Evangelos Papadopoulos, Greece, and Catherine Streeton, Australia.

North American Travel Medicine Review and Update Course

Many thanks to Co-Chairs Nancy Piper-Jenks, United States of America, and Sheila Mackell, United States of America, and all the faculty who helped make the 2018 Course in Atlanta so successful. Attendees enjoy the time with the faculty in this traditional classroom setting, but the committee and course faculty will be exploring the possibility of trying to create some on line learning modules or course as another venue for member learning.

Global Availability of Rabies and JE Vaccines

Now all members are able to update their clinic information with their Rabies and JE vaccine availability. This is an important resource for our travellers in case they need to complete JE or Rabies vaccine series or experience a bite during their travels. You can search by going to the Global Travel Clinic Directory tab on the left side of the ISTM home page, put in the country, click what you are searching for i.e. Rabies, JE, Yellow fever vaccine etc. and hit search. Please check this database before posting a general query to the Travel Med list serve forum. But this database will only be as good as we make it, so if you haven't updated your clinic information yet, please do so.

Professional Education

Chair: Mary-Louise Scully, United States of AmericaCo-Chair: Marc Shaw, New ZealandCourse Co-Chairs:
Sheila Mackell, United States of America
Nancy Piper-Jenks, United States of AmericaWebinar Chair: Sarah Kohl, United States of AmericaMembers:
Susan Anderson, United States of America
Elizabeth Barnett, United States of America
Michele Barry, United States of America
Garth Brink, South Africa
Yen Bui, Canada
I. Dale Carroll, United States of America
Lin H. Chen, United States of America
Carolyn Driver, United Kingdom
Philippe Gautret, France
Effrossyni Gkrania-Klotsas, United Kingdom
Michael Holzer, United States of America
Susan L.F. McLellan, United States of America
Dipti Patel, United Kingdom
Gail Rosselot, United States of America

Research and Awards

Chair: Martin Grobusch, The NetherlandsCo-Chair: Mary Wilson, United States of AmericaMembers:
Elizabeth Barnett, United States of America
Jose Flores, Mexico
Katherine Gibney, Australia
Stefan Hagmann, United States of America
David Hamer, United States of America
Emily Jentes, United States of America
Eyal Leshem, Israel
Sarah McGuinness, Australia
Eskild Petersen, Oman/Denmark
Kyle Petersen, United States of America
Mark Riddle, United States of America
Mirella Salvatore, United States of America
Dawd Siraj, United States of America
Hai-Bo Wang, China
Adrienne Willcox, United Kingdom

Older Traveller

Pediatrics

Chair: Stefan Hagmann, United States of America Immediate Past Chair: Mike Starr, Australia Council Members:
John Christenson, United States of America
Philip Fischer, United States of America
Sarah Kohl, United States of America
Eyal Leshem, Israel
Sheila Mackell, United States of America
Shirley Molitor-Kirsch, United States of America
Harunor Rashid, Australia

Responsible Travel

Student Travel Abroad

Chair: Mark Newell, Australia Immediate Past Chair: Sarah Kohl, United States of AmericaCouncil Members:
Jorge Baruch Diaz Ramirez, Mexico
Catherine Ebelke, United States of America
Marie Plisson-Saune, France
Julie Richards, United States of America
Gail Rosselot, United States of America
Dawd Siraj, United States of America

Local Organizing Committee

Chair: Mark Riddle, United States of AmericaMembers:
Bradley Connor, United States of America
Patrick Hickey, United States of America
Noreen Hynes, United States of America
Sarah Kohl, United States of America
Greg Martin, United States of America
Kyle Petersen, United States of America
Thomas Valk, United States of America